"10% na raunin idon kafa yana tare da distal tibiofibular syndesmosis rauni. Nazarin ya nuna cewa 52% na distal tibiofibular screws yana haifar da raguwa mara kyau na syndesmosis. Shigar da distal tibiofibular dunƙule a daidai lokacin da syndesmosis hadin gwiwa surface yana da muhimmanci don kauce wa iatrogenic malreduction. Bisa ga littafin AO, ana ba da shawarar shigar da distal tibiofibular dunƙule 2 cm ko 3.5 cm sama da distal tibial articular surface, a kusurwar 20-30 ° zuwa jirgin sama a kwance, daga fibula zuwa tibia, tare da idon kafa. a cikin tsaka tsaki."
Shigar da hannu na distal tibiofibular screws sau da yawa yakan haifar da sabawa a wurin shigarwa da shugabanci, kuma a halin yanzu, babu wata hanya ta dace don ƙayyade hanyar shigar da waɗannan sukurori. Don magance wannan batu, masu bincike na kasashen waje sun ɗauki sabuwar hanya - 'hanyar bisector angle.
Yin amfani da bayanan hoto daga haɗin gwiwar idon kafa na al'ada 16, an ƙirƙiri nau'ikan bugu na 16 3D. A nisa na 2 cm da 3.5 cm sama da tibial articular surface, biyu 1.6 mm Kirschner wayoyi a layi daya da haɗin gwiwa surface an sanya su kusa da gaba da na baya gefuna na tibia da fibula, bi da bi. An auna kusurwar da ke tsakanin wayoyi biyu na Kirschner ta hanyar amfani da protractor, kuma an yi amfani da 2.7 mm drill bit don tono rami tare da layin bisector na kusurwa, sannan a saka 3.5 mm dunƙule. Bayan shigar da dunƙule dunƙule, an yanke dunƙule tare da tsawonsa ta amfani da zato don kimanta alakar da ke tsakanin jagorar dunƙule da tsakiyar axis na tibia da fibula.
Gwaje-gwajen samfuri sun nuna cewa akwai daidaito mai kyau tsakanin tsakiyar tsakiya na tibia da fibula da layin bisector na kusurwa, da kuma tsakanin tsakiyar tsakiya da kuma jagorancin kullun.
A zahiri, wannan hanyar na iya sanya dunƙulewa tare da tsakiyar axis na tibia da fibula. Koyaya, yayin aikin tiyata, sanya wayoyi na Kirschner kusa da gaba da gefuna na baya na tibia da fibula yana haifar da haɗarin lalata jijiyoyin jini da jijiyoyi. Bugu da ƙari, wannan hanyar ba za ta warware matsalar iatrogenic malreduction ba, saboda ba za a iya kimanta daidaitaccen tibiofibular ba daidai ba kafin a sanya shi.
Lokacin aikawa: Yuli-30-2024
